AN INTRODUCTION TO OFFICE DISPENSING

(Reprinted with permission from Cosmetic Dermatology Supplement 7/00)

Societal influences to appear youthful, along with the impact of managed care, have together fostered an evolution in dermatology focused on cosmetic procedures. Dermatologists are in a unique position to direct the future of their profession and widen their role as skin care experts. This is best achieved by focusing on the continuum of skin care, from office-based procedures to home care treatments. Dermatologists who offer a variety of skin peels are best situated to capture this rapidly expanding segment of dermatology. The inclusion of office-based as well as at-home therapeutic regimens generates a win-win situation; patients are rewarded with the improved appearance and healthier skin they anxiously seek and dermatologists are better situated to avoid the pitfalls of managed care while enhancing their practice.

Dermatologists are the ideal specialists who can provide patients with the expert skin care treatments, based on sound scientific evidence, that actually yield positive results. The dermatologist is the most capable person to evaluate a patient's needs and plot a course of treatment. When it comes to skin care, the dermatologist is also the most knowledgeable in evaluating which product or technique is most appropriate for his/her patients. Although the beautician or esthetician has knowledge in the field of skin care, they are not as equipped as the dermatologist to make appropriate therapeutic or product recommendations. Dermatologists improve the likelihood of patients achieving individualized skin care goals by offering in-office dispensing.

Peels are an ideal vehicle for launching in-office dispensing. There are a variety of pre- and post-peel products containing Alpha Hydroxyacids (AHA) and Poly Hydroxyacids (PHA) that improve the outcome of the peel (cleansers and moisturizers). These products are compatible with all skin types and are available in a broad therapeutic line to facilitate office dispensing. An added benefit of basing a dispensing program on peels is that many of these products are only available to dermatologists, which eliminates the problem of carrying products that are available in department store and drug store cosmetic counters.

 

STEPS TO BECOMING A DISPENSING OFFICE

Step 1: Map out a business plan with time frames and expectations. The plan should be separate from, but a component of, the practice's plan.

Step 2: Learn about the available products. The physician should always be the one to make the initial recommendation of products to the patient. This responsibility should not fall on the staff; it is less professional and minimizes the rationale for patients to purchase products from you. The staff can assume the role of providing refills and mapping out at-home instructions.

A dermatologist should not recommend a product that he/she is not familiar with or is uncomfortable dispensing. Becoming acquainted with the scientific evidence behind the products in order to explain the benefits to patients. Assist patients to formulate realistic and appropriate goals. Products are often complimentary, so that once a patient is satisfied with the results of one product, other items can then be added. This tiered approach improves patient satisfaction and results without overwhelming the patient with a multitude of products all at once. The more satisfied and greater results a patient sees, the more likely he/she is to be receptive to additions to the treatment plan.

Step 3: Select the brands and products to supply. There are countless products available. Some dermatologists carry as few as 20 products while others may carry more than 100. It all depends upon the volume of patients in the practice. The typical dermatologist carries several product lines, a few dozen products, and includes a tiered product approach.

Dermatologists who accept patients from third-party payers may want to stock one less expensive line of products so that a broader range of patients can benefit from them. Initially, select a limited inventory of products that is best for the patient population. As the practice expands, a wider range of products can always be added.

Find out what the initial inventory may cost and what payment schedule is required. Products purchased from pharmacy wholesalers typically carry a net due of 15 days. Dermatologists generally have much greater success and longer terms when purchasing products directly from the manufacturer.

Step 4: Determine the best display area and where individual consultations can be held. There is no tried and true rule for this. Some offices do better with products behind the counter in a very discrete location, whereas others are quite successful with a large display area in the waiting room. Some dermatologists offer a day spa-type setting and sell the products there. It is all dependent upon the type of practice and the image conveyed. The manufacturers' service consultants are often able to provide assistance in this area. A good display can make this endeavor successful just as readily as a poor display can doom it from the start. It is important to pay attention to this. Factors to consider include: space, lighting, privacy, storage, etc. A good avenue to explore to enter the dispensing arena is through internet commerce sites. For a small annual fee, the physician can access a virtual "storefront" and order products on-line. It is worth exploring, as many e-commerce sites are being established that are specifically dedicated to physicians.

Step 5: Have products delivered and have the office staff trained. Appropriate storage space is important. It must be a temperature controlled and secure area. Make sure that all staff members are familiar with the array of products; patients are likely to ask their opinion of items. Decide if the staff will sample products and become personally familiar with them. Some manufacturers may provide a sampling of products for office personnel.

Step 6: Stay current on products and how they differ from those selected. Do not carry every new product; it is impossible to have everything. When adding a new product, many dermatologists deleted an outdated or slow-moving product. Keep abreast of current pricing of the products sold (both what you sell and what your competitors sell). Patients are often aware of pricing throughout the area and may ask pricing questions; be prepared to address these issues.

NOTES ON DISPENSING

  • Dispensing generally only entails non-prescription items.
  • Most physicians purchase items for dispensing from the manufacturer.
  • Main benefits of dispensing are income enhancement and improved patient satisfaction.
  • Decide in advance if the staff is to be paid commission or given established incentives.
  • Provide appropriate space and inventory of products in office and in storage.

Step 7: Consider the benefits of a computerized inventory control system that sets reorder levels and works with bar codes. Anyone who dispenses a significant volume of products will need a computerized bar-coded system to keep up with products. These systems also provide added safety in that patients may forget the products they use, and the bar coded label in their chart will prevent the staff from dispensing the wrong product.

 

HOW TO GENERATE PATIENT INTEREST

Today, people are inundated by the media's focus on ways to reverse the aging process. For example, there are hundreds of over-the-counter preparations that contain AHAs on the market. These products have an estimated annual sales of at least two billion dollars worldwide. They are especially beneficial when combined with peels to yield excelled patient outcomes with diminished signs of aging and reversal of photodamage.

To alert patients to the expanded capabilities of a practice, consider:

  • Arranging attractive displays for the products
  • Having promotional material in the waiting area
  • Displaying informational brochures
  • Mailing literature, newsletters, and special promotions to your patient base or to a list of potential patients
  • Offering specifically targeted skin care consultants
  • Offering a "Buy 1 get a free sample" on products, peels, or microdermabrasion.

TRIED AND TRUE

  • One physician's office uses a UV camera to provide complimentary photographs and handouts about photodamage and the NeoStrata¨ program.
  • Another physician has a web site that attracts patients from all over the United States. His office has shipped more than 3,000 products to six continents.
  • Consider mailing a letter, a coupon for a complimentary consultation, and a discount on home care products or skin rejuvenation peels.

HOW TO MERCHANDISE PROFESSIONALLY

All recommendations for use of skin care products should initially come from the dermatologist. Ascertaining the patient's level of interest in products is an important first step. Do not push resistant patients if there is no demonstrated interest. Also, avoid encouraging products with patients whom you believe will not use them. Patients who demonstrate an interest should be started on one or two products at a time - a stepped approach - and then with subsequent office visits have additional products added to complete their therapeutic regimen. Once patients see positive results with the initial products, others can then be added.

Dermatologists often give seminars to draw patients into their practice and increase their existing patient base. A good source for these are local corporations, hospitals, health clubs, country clubs, beauty salons, and spas. Topics may include treatment of photodamaged skin, facial rejuvenation, dry skin care, or general skin care. Local newspaper, talk radio, or television are other highly desirable and visible methods for reaching new patients and becoming known as the skin care expert in your region. Another useful way to educate patients and provide a value-added service is through a web site. A presence on-line allows dermatologists to convey information about their experience and training, board certification, staff and facility, directions to the office, and hours of operation. It also provides a means for patients to gather information concerning procedures, risks, and recovery 24 hours a day, 7 days a week. Some physicians' sites include e-commerce for ordering products and hyperlinks to manufacturers' sites, and an imaging system for online photo consultations.

1.Klighman AM. The compatibility of glycolic acid and tretinoin in acne and photoaged facial skin. J Geriatr Dermatol, Suppl A. 1995:25A-28A

ROLE OF STAFF

The physician should always make the initial product recommendation. This is key to maintaining professionalism and respect. However, office personnel or skin care specialists can provide an essential role in running and growing the skin care portion of your business. In fact, properly trained professionals can spend time with patients generating interest in new products, offering samples, performing follow-up, and dispensing refills.

An important decision is if staff are to be paid commission for the products sold. This is an individual consideration based on the practice and staff. Rewards and incentives can be given in ways other than commission with periodic bonuses, gifts, or recognition. If a commission program is established, monitor it carefully so that professionalism is maintained and staff are not perceived as pushing products on patients.

Providing staff with samples of products facilitates the 'testimonial' approach that is appealing to some patients. Staff members who use the products themselves also feel a different level of participation in the program and become interested in its success. Motivational training for office personnel is also a key factor. Product consumer service representatives are an excellent resource in this area. They may be able to schedule bi-annual or quarterly updates which also serve to motivate and establish benchmarks for performance among staff. Find out who the best resources are and do not hesitate to use them.

As was mentioned previously, patient compliance is a crucial component to assure the success of the at-home skin care regimen, and staff can make available and review clear, concise, written instructions for the patient to talk with them. Staff can direct patients to brochures, videos, web sites, and other sources of information to answer questions on specific products. An additional tool is the use of a sample basket, for example, a dry skin basket containing a variety of products that the nurse can assist the patient in using. For patients, this is a comfortable introduction to the products dispensed.

The services of an esthetician can be beneficial to the operation of a cosmetic dermatologist's office. Physicians who offer microdermabrasion and facials often hire estheticians to assist with or entirely do these services. A well-trained esthetician who is clear about his/her place within the practice can provide valuable services, increase revenues, and improve patient satisfaction. Present the esthetician's services as an adjunct to the dermatologist and under the direct supervision of a dermatologist; this is a position that is at a higher, more professional level than free-standing estheticians in the community.

CONCLUSION

Once patients learn that their trusted dermatologist can provide superior products than are available commercially, the rest comes naturally.

However, the physician's reputation cannot be compromised. The products recommended should be appropriate for and individualized to each patient with regard to their skin type, skin care needs, treatment plan, and ability to afford.

Dispensing is more than just carrying products. It is an opportunity for and the responsibility of the dermatologist to help the patient continue their skin care therapy at home. Once the rejuvenation process is initiated with the peel, the patient can take an active role in helping renew and maintain his/her healthy skin. Carrying a professional line of skin care products is a way to enhance business; becoming an expert on skin care products and procedures gives credibility with patients and peers. Professional dispensing of products can bring more patients into the office in the first place and increase return visits. The ultimate reward from introducing patients to quality products is the value-added service and education provided and the increased patient satisfaction that comes with it.


WORDS OF WISDOM FOR THE HIGH VOLUME DISPENSING EXPERT DERMOTOLIGISTS

When it comes to in-office dispensing, the number one consideration is that the physician must be the leader of the process. Neither the staff nor the manufacturers' representatives should take the lead; it has to be the dermatologist if it is to be successful, credible, and ethical. No one is better able to determine the skin care needs of each patient than the prescribing physician. The dermatologist's reputation and the respect shown by patients is an important position to maintain. The physician must exercise professional behavior at all times and not appear to be driven by profits, but by patient advocacy. All initial recommendations for product use should come from the physician and be adjunctive to whatever treatment is being done in the office.

The products selected and recommended to patients should be appropriate, individualized, and based on: type of skin, skin disorder and skin care needs, treatment plan, and the patient's ability to easily afford the product(s). An additional consideration is an estimate of the patient's anticipated compliance, because if the patient is going to be non-compliant with use of products, there is little reason to dispense them in the first place.

The physician should be quite knowledgeable about the products that are available in the office. If the dermatologist is not familiar with a particular product, it should not be recommended. Product knowledge gives credibility.

To generate interest in cosmetic procedures, hold seminars in the office after hours. Lecture on the medical aspects of anti-aging treatment and have allied health personnel demonstrate mini-procedures. An alternative to this is to lecture at women's groups, local corporations, health fairs, and community organizations on current issues in dermatology, facial rejuvenation, or photoaging. Over time this type of exposure builds interest and volume in a practice.

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